Steady advances in pancreatic cancer treatment are improving outcomes
When Harriet Wulfstat visited the Great Wall of China in 2006, she posed for a picture with her arms outstretched, making V for victory signs with her fingers in a playful nod to President Nixon’s historic trip decades earlier. She did not know it then, but soon victory over cancer would be her number one goal.
The very same day as that exhilarating visit, Wulfstat, then 65, noticed something odd: her urine was brown. After some tests following her return, she received shocking news: She had pancreatic cancer.
“You have cancer” are words that no one wants to hear. A diagnosis of pancreatic cancer, though, is especially heart wrenching. It’s one of the most deadly cancers, comprising only 3.2 percent of cancer diagnoses in the United States in 2017, but 7.2 percent of cancer deaths. Its five-year survival rate is 8.2 percent, compared with, for example, 89.7 percent for female breast cancer.
Yet there’s reason for hope. The current five-year survival rate is more than three percentage points higher than it was in 2000, and pancreatic cancer experts say that steady advances in prevention, diagnosis and treatment are leading to better prognoses for people with the disease.
A hidden, but vital, gland
The pancreas is a gland about six inches long that makes insulin and secretes digestive enzymes. Its position, tucked between the stomach and the spine, means that tumors can’t be felt externally and may be missed in imaging tests.
Its position has another problem. Because the pancreas is sandwiched next to the stomach, gallbladder and small intestines, the tumor can quickly grow into other organs, making it difficult for a surgeon to remove, says Asha Dhanarajan, MD, an assistant professor of hematology and oncology at Loyola Medicine.
The gland’s location near so many blood vessels also causes difficulties, notes Rich Siegel, MD, an oncologist with Illinois Cancer Specialists in Arlington Heights. “Many pancreatic cancers encase major blood vessels that run through the pancreas, which makes curative resection [surgery to remove or destroy the cancer tissue] impossible in many cases,” he says.
About 95 percent of pancreatic cancer cases originate in the exocrine cells, which secrete enzymes that help with digestion. The remaining 5 percent of cases stem from the neuroendocrine cells, which create insulin and other hormones. People with the neuroendocrine form of pancreatic cancer generally have a better prognosis, Dhanarajan says.
Pancreatic cancer can strike anyone, but it’s more apt to develop in people who are older. People who smoke, are obese or have chronic pancreatitis or diabetes are more vulnerable to developing the disease.
In addition, mutations in the BRCA1 and BRCA2 genes, which also increase the risk of developing breast and ovarian cancer, can elevate a person’s risk of developing pancreatic cancer with a lifetime risk of up to 7 percent, says Jessica Stoll, MS, CGC, a genetic counselor at UChicago Medicine. Lynch syndrome (hereditary nonpolyposis colorectal cancer) and PALB2 mutations are among other genes that can increase the risk.
A quiet cancer
In its early stages, pancreatic cancer often does not cause any symptoms. As it advances, people may experience abdominal pain, back pain, weight loss, jaundice, blood clotting and the sudden onset of diabetes.
Unlike breast or colon cancer, there’s no simple screening test. Endoscopic ultrasounds can detect pancreatic tumors, but they are expensive, invasive and generally not recommended for the general public, Siegel says.
Jim Rolfe knows all too well how difficult it can be to detect pancreatic cancer early. His father, Michael Rolfe, was 61 when he died of the disease in March 1999, just two weeks after diagnosis.
After his father passed away, Rolfe, other family members and friends started the Rolfe Foundation, based in Chicago, to raise funds for pancreatic cancer research and provide support to people with pancreatic cancer and their families.
Knowing your family history is key, Rolfe stresses. To help people map their family history of cancer, the Rolfe Foundation has a downloadable form on its website. Once a person knows if their family is at increased risk, they can talk to their physician or genetic counselor.
Searching for better treatment
Treatment for pancreatic cancer may include surgery, chemotherapy and radiation. Surgery, however, can only be performed when the cancer has not spread, Siegel says.
If the cancer is at the head of the pancreas, a surgical procedure called the Whipple may be performed, Dhanarajan says, in which part of the pancreas is removed along with the gallbladder, part of the small intestine, a portion of the bile ducts and the lymph nodes near the pancreas. If the cancer is in the tail of the pancreas, a simpler surgery may be performed.
Oncologists are hopeful that in coming years they will have more treatment options to offer pancreatic cancer patients. Immunotherapy, which has dramatically improved survival for people with melanoma and other cancers, hasn’t yet proved to be effective for pancreatic cancer, but researchers are studying different immunotherapy drugs and combinations to find ones that may work, Dhanarajan says.
Clinical trials are studying whether drugs called PARP inhibitors, approved for some women with advanced ovarian cancer who have a BRCA mutation, might also be effective for people who have pancreatic cancer and a BRCA mutation.
Irreversible electroporation — NanoKnife — technology has been demonstrated to improve surgical outcomes, Siegel says. Also, research is in progress to identify precise molecular markers of various types of cancers at their very earliest stages.
Advice to patients
Rolfe and Wulfstat recommend that people with pancreatic cancer contact the Rolfe Foundation for help connecting with oncologists and pancreatic treatment centers. Dhanarajan also suggests they seek care at a medical facility that treats a large number of patients with pancreatic cancer and participates in clinical trials. The Pancreatic Cancer Action Network is another good resource for patients, she says.
Finally, a positive attitude is important, says Wulfstat, who is currently undergoing treatment for a re-emergence of her cancer. “I have been able to put my fears in a cubicle, close the top and concentrate on the next step.”
As for Rolfe, his dream is that the foundation established in his father’s memory could someday close its doors.
“Our ultimate goal is to go out of business because we’ve got an early detection test and a cure,” he says.